Medical Drug Claim Edits to Optimize Reimbursement – White Paper – Ensure claims payment accuracy, compliance

Our latest white paper demonstrates the value and versatility of an automated medical drug claim edits solution. RJ Health’s system implements a rules-driven platform to reduce overall medical drug claims errors and improve overall efficiency. Appropriate reimbursement for drugs covered by the medical benefit increasingly requires more data and structure. Many of the billing systems that currently exist cannot handle the increased load. Organizations may resort to increasing headcount and/or outsourcing, but this can lead to suboptimal results.

As health plans evolve, the complexity of how medically covered drugs are grouped, coded, and priced increases. Additionally, products and coding don’t always match 1-to-1.

Increasing complexity associated with proper drug reimbursement
imparts challenges with:

Handling System Limitations

Ensuring Payment Accuracy

Compliance with Policies, Fee Schedules

Ensuring Utilized Data is up to Date

increase accuracy, automation, and ROI with RJ Health

DOWNLOAD our latest white paper:

Medical Drug Claim Edits to Optimize Reimbursement


Todd Cooperman PharmD, MBA, R.Ph.
Senior Vice President, Clinical Insights and Analytics


Wendy Sullivan, MPH

Director, Data Informatics


View our library of previous white papers HERE.